Introduction
Up to half of inflammatory bowel disease (IBD) patients experience chronic pain despite disease remission. The factors affecting the development of chronic pain are poorly understood and pain-directed therapies are scarce. Our study aimed to compare the clinical features and psychological characteristics of patients with and without chronic abdominal pain (CAP). The current analysis focuses on patients with IBD in remission and used REDCap to capture electronic data [1].
Aims & Methods
This is a cross-sectional online questionnaire-based study of 2381 IBD patients aged 16 years and above. The Rome IV questionnaire was used to diagnose irritable bowel syndrome (IBS). Remission was defined as Harvey Bradford Index (HBI) < 5 for patients with Crohn’s disease (CD) or Simple Colitis Activity Index (SCAI) < 3 for patients with ulcerative colitis (UC) [2]. Participants in remission with at least weekly abdominal pain for at least three months were defined as the cohort with chronic abdominal pain, and the rest were categorised as the pain-free cohort. The independent samples t-test was used to compare mean Body Mass Index (BMI) and age at diagnosis, and the independent samples Mann Whitney U test to compare the non-parametric scale data of the two cohorts. Spearman’s correlation was used to compare the pain intensity and pain interference scores from the Brief Pain Inventory with scale data from the following scales: Big Five Personality Questionnaire (BFPQ), Highly Sensitive Person Scale (HSPS), General Anxiety Disorder-7 (GAD7), Patient Health Questionnaire 9 (PHQ9), and Cognitive and Behavioural Response Questionnaire (CBRQ). Cronbach’s alpha was used to assess the reliability of these scales.
Results
1191 participants in remission were studied. Their ages ranged from 17 to 92, with a mean age of 51, and 52.6% were male. Eighty-eight percent were of White British ethnic origin and 40% were current or previous smokers.
25.9% (308) of those in remission reported CAP, with a mean age of 47 years, and 41.6% of them were males. The mean age at diagnosis of IBD was 35 years in those with CAP in remission, versus 30 in those without CAP (t= -4.548, p <0.001, 95% CI -6.598 to -2.621). In the CAP group, the prevalence of IBS was 73.1% compared to the total prevalence of 18.9% in the remission cohort. The prevalence of CD and UC were 72.4% and 27.6% respectively in the CAP in remission cohort, compared to 61.3% and 38.7% in all remission participants. 34.4% of people with CAP in remission had previous surgery.
There was a significant difference between the CAP and non-CAP cohort median scores with p values < 0.001 for neuroticism from the BFPQ, Ease of Excitation (EoE) from the HSPS, GAD7, PHQ9. The CBRQ components of fear avoidance, embarrassment avoidance, symptom focusing, all-or-nothing behaviour score, and avoidance/resting behaviour score also showed differences between the CAP and non-CAP groups (p <0.001, 95 % confidence interval). Pain intensity and pain interference scores showed positive correlations significant at the 0.01 level with neuroticism, EoE, GAD7, PHQ9, and all components of the CBRQ except catastrophisation score within the CAP in remission group.
Conclusion
Our results demonstrate that an older age at diagnosis, IBS prevalence, Crohn’s disease, neurotic personality type, and certain behavioural and psychological profiles are significant features of IBD patients with chronic abdominal pain in remission. Further studies will help to develop management strategies and to establish causality.
References
1. Farrokhyar, F., et al., Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: Prevalence and impact on health. Inflammatory Bowel Diseases, 2006. 12(1): p. 38-46.
2. Srinath, A.I., et al., Predictors of abdominal pain in depressed pediatric inflammatory bowel disease patients. Inflamm Bowel Dis, 2014. 20(8): p. 1329-40.
3. Harris, P.A., et al., Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform, 2009. 42(2): p. 377-81.
4. Teruel, C., E. Garrido, and F. Mesonero, Diagnosis and management of functional symptoms in inflammatory bowel disease in remission. World J Gastrointest Pharmacol Ther, 2016. 7(1): p. 78-90.
*Dr Ruqaya Idrees and Dr Pavit Luthra are joint first authors on this abstract.